N/IICU Clinical Pathway for the Evaluation and Management of Patent Ductus Arteriosus (PDA) in Neonates Born < 29 wks Gestational Age
- A hemodynamically significant PDA (hsPDA) is a PDA causing both clinical and echocardiographic changes that has significant impact on the physiologic stability of the neonate
- Avoid preventative or routine treatment of a hsPDA in neonates < 14 days old
- Evaluation and pharmacologic treatment for neonates between 14–28 days old should be reserved for those with significant clinical symptoms
Summary of Pathway Updates
Adapted from AAP Guidelines 2025 and Recent Studies
Adapted from AAP Guidelines 2025 and Recent Studies
Evaluation and Management of PDA in Neonate < 29 wks GA
- Exclusions
- Congenital heart disease
- Pulmonary hypertension
- > 28 days of age, Consult Cardiology
Mild or Few Moderate Symptoms
Multiple Moderate or > 1 Severe Symptoms
- Conservative Clinical Management
- Fluid restriction
- Increasing PEEP
- Enteral Feedings
Clinical worsening
Obtain Echocardiogram
Small non-hsPDA or moderate hsPDA
Large hsPDA
Discharge
- Discuss with cardiology
- Discharge Echocardiogram
- Follow-Up Plan
Stable
- Continue conservative clinical management
- Enteral Feedings
Clinical worsening
- Consider conservative clinical management in infants < 28 days old
- or
- Pharmacological Treatment
- Enteral Feedings
Clinical worsening
- Repeat Echocardiogram
- Consider second Pharmacologic Treatment
- Consider discussing Percutaneous (Transcatheter) PDA Closure with Interventional Cardiology
Clinical worsening
- Repeat Echocardiogram
- Discuss Percutaneous (Transcatheter) PDA Closure with Interventional Cardiology
- Discuss with cardiology
- Discharge Echocardiogram
- Follow-Up Plan
Evidence
- New!
Expectant Management vs. Medication for Patent Ductus Arteriosus in Preterm Infants The PDA Randomized Clinical Trial - New!
AAP COFN Statement: Patent Ductus Arteriosus in Preterm Infants - Patent Ductus Arteriosus: A Contemporary Perspective for the Pediatric and Adult Cardiac Care Provider
- Beneficial vs. Harmful Effects of Pharmacological Treatment of Patent Ductus Arteriosus: A Bayesian Meta-Analysis
- Paracetamol (Acetaminophen) for Patent Ductus Arteriosus in Preterm or Low Birth Weight Infants
- Nutrition of the Preterm Infant with Persistent Ductus Arteriosus
- Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm or Low Birth Weight (or Both) Infants
- The Definition of a Hemodynamic Significant Duct in Randomized Controlled Trials
- Towards Rational Management of the Patent Ductus Arteriosus: the Need for Disease Staging
- Prophylactic Indomethacin and Intestinal Perforation in Extremely Low Birth Weight Infants
- Feeding Preterm Neonates with Patent Ductus Arteriosus (PDA): Intestinal Blood Flow Characteristics and Clinical Outcomes
- Tolerance to Early Human Milk Feeding is Not Compromised by Indomethacin in Preterm Infants with Persistent Ductus Arteriosus
- Enteral Feeding During Indomethacin and Ibuprofen Treatment of a Patent Ductus Arteriosus